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Responding to intimate partner violence: Six messages from research for health and social care professionals

16 Days of Activism against Gender-Based Violence is a global awareness raising campaign calling for the prevention and elimination of violence against women and girls. It takes place annually from the UN Day For the Elimination of Violence against Women (25th of November) to International Human Rights Day (the 10th December). Ruth Geraghty looks at the research on Intimate Partner Violence, and summarises key messages for health and social care professionals.

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This year, the COVID-19 pandemic shone a light on the issue of domestic violence, as the restrictions enacted to curb the spread of the virus greatly exacerbated the opportunity for violence and coercive control. Global media reports of a surge in domestic violence during the period of lockdown resulted in a call from the Secretary-General of the UN in April 2020 for national governments to make prevention and redress of violence against women a key part of their national response plans for COVID-19. In Ireland, Operation Faoiseamh was launched in April, and involved over 15 thousand contacts to victims between January and October, and led to 107 prosecutions during May. However, research has consistently found that victims are unlikely to report domestic abuse to the police and are more likely to disclose their experience to a healthcare practitioner than to any other service. Health and social care therefore present a key opportunity detect and respond to domestic violence.

What we mean by Intimate Partner Violence

In 2020, CES undertook a rapid review of the evidence on domestic violence, as part of our Access Evidence series of evidence briefs for front line practitioners in health and social services. Our review focuses on Intimate Partner Violence (IPV) which refers to any behaviour within an intimate relationship that causes physical, sexual, psychological or financial harm to those in the relationship. The legislation applies to all types of intimate relationship regardless of marital status, sexual orientation, whether the couple are cohabiting, and is applicable to either a current or previous relationship.

The role of frontline practitioners

Health and social care practitioners play an important role in recognising the signs and symptoms of abuse and may want to have a greater understanding of some of the risk factors, to recognise the warning signs, and to determine what they can do to support someone experiencing IPV. Practitioners should also have a good knowledge of local agencies, services and networks for domestic violence, so that a person experiencing IPV can be referred to the support and services they need wherever possible.

Our review of the evidence, which includes guidance materials from statutory and voluntary agencies, highlights the following six messages.

1. She may find it hard to seek help: Estimates for help seeking are very low, ranging from 4% to 27% and many victims never disclose their experience of IPV to anyone. The reasons include fears about social stigma, retaliatory violence, and fear of setting in motion a process they will no longer have control over, such as the involvement of social services. Public discourses about IPV frequently depict victims as young, heterosexual females, and people who do not fit this profile (male victims, older victims, victims from same sex couples, for example) can find it especially difficult to seek help.

2. The strongest determinant of disclosure is clinician inquiry: While universal screening for domestic violence is not recommended or evidenced by the research, it has been found that most women do not object to being asked about domestic violence. The guidance literature recommends asking simple, direct questions.

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3. She may not be thinking of leaving her abuser: A victim may have very practical reasons for remaining in an abusive relationship, and what might be interpreted as inaction may in fact be the result of a calculated assessment. She may fear for her safety or that of her children and other dependents. She may not want to break up the family or may be under pressure from extended family or her community to stay in the abusive relationship. She may be hopeful that the abuse will resolve on its own over time. Minority groups are particularly vulnerable due to social isolation, dependence on the perpetrator and restricted access to support services (for more on this, see the Specific Needs and Protection Orders report from Safeireland)

4. Help seeking is a journey: Help seeking involves a series of judgments and actions, rather than a single event. A victim may leave and return to the abusive relationship a number of times. Abuse tends to be cyclical in nature, where violent episodes are followed by periods of perpetrator remorse. Once in a ‘cold state’, the victim may feel overwhelmed or unable to engage in a drawn out criminal justice procedure, causing them to retract their statement. Many victims do eventually leave, often after a trigger, excuse or opportunity arises, such as the need to protect a child, or a particularly severe incident of abuse.

5. She is best placed to know when the time is right to act: The research highlights the victim’s sense of risk as an important factor in determining the likelihood of re-assault. A risk assessment provides a framework by which a practitioner can identify the signs of escalating violence and take the appropriate response. A risk assessment should also take account of whether there are children or other vulnerable adults in the household, and whether any of the abuse has been extremely physical or life threatening. If the victim and family members, are not in immediate danger, the health and social practitioner, as a social prescriber, can refer the victim to support services for domestic violence.

6. The most dangerous time is when she is about to leave and the 12 months following separation: There can be an intensification of the abuse during the period of separation, particularly if the perpetrator feels he is losing control of the victim. Digital technology can provide the perpetrator a means of terrorising their ex-partner, such as sending threatening messages, stalking, and posting, or threatening to post, sexually explicit visual material online. The behaviours associated with IPV typically precede intimate partner homicide. In the UK, between 2009 and 2015, 76% of women that were killed by their ex-partner or ex-spouse were killed within the first year of their separation; a third were killed within a month. According to the Australia study, Just to Say Goodbye (2013), children are at particular risk at the time of separation, especially in relation to ‘retaliatory filicide’ where “children are killed by abusive fathers as an act of revenge against the mother after separation”.

The way in which a health or social care practitioner responds to a disclosure of IPV is of vital importance as it can influence the next steps she takes. Even providing information on domestic violence support services (or her local refuge) is a good outcome, with due care for confidentiality and protection from retaliatory violence. In recent years a number of training materials have been created for practitioners and for other settings where domestic violence may become apparent, such as the workplace. In-person training can often be provided from domestic violence support services, on request.

Download the full tip sheet below. The evidence review on Intimate Partner Violence will be available on the CES website in 2021. Other Access Evidence resources are available here.